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| There are ways out of our care crisis, if only May had the guts to pick one | There are ways out of our care crisis, if only May had the guts to pick one |
| (30 days later) | |
| The stagnation of this stymied government is remarkable. A new government’s first year is prime time for hyperactivity but, to use the prime minister’s famous phrase: “Nothing has changed.” Brexit sucks out the air – though even that makes no progress. | The stagnation of this stymied government is remarkable. A new government’s first year is prime time for hyperactivity but, to use the prime minister’s famous phrase: “Nothing has changed.” Brexit sucks out the air – though even that makes no progress. |
| Social care offers the best illustration of paralysis, and you can see why: this toxic topic cost Theresa May her majority when her “dementia tax” exploded mid-campaign last year. A green paper promised by summer 2017 was postponed to “before the 2018 summer recess”, but the word is that it’s delayed again. There have been at least 12 government green papers, white papers and commissions since 1998, all recommendations left on the shelf, as politicians recoil from politically horrible options: either the Treasury spends a shed-load more, or it takes extra means testing and tax rises on exceptionally resistant groups. Social care fell into the too-difficult red box. | Social care offers the best illustration of paralysis, and you can see why: this toxic topic cost Theresa May her majority when her “dementia tax” exploded mid-campaign last year. A green paper promised by summer 2017 was postponed to “before the 2018 summer recess”, but the word is that it’s delayed again. There have been at least 12 government green papers, white papers and commissions since 1998, all recommendations left on the shelf, as politicians recoil from politically horrible options: either the Treasury spends a shed-load more, or it takes extra means testing and tax rises on exceptionally resistant groups. Social care fell into the too-difficult red box. |
| How about universal free care? It’s the most expensive option but only £2bn above May’s proposal | How about universal free care? It’s the most expensive option but only £2bn above May’s proposal |
| Meanwhile, the crisis escalates behind the lace curtains of neglected, frail old people. Social care is not politically noisy like A&E, because the public are conveniently clueless about it until they need care for a relative – too few at any one time to force action. | Meanwhile, the crisis escalates behind the lace curtains of neglected, frail old people. Social care is not politically noisy like A&E, because the public are conveniently clueless about it until they need care for a relative – too few at any one time to force action. |
| Monday saw yet another care-home sell-off as Britain’s biggest provider, HC-One, went up for sale with 369 care homes. Four Seasons was taken over, after making a £450m loss for its private equity owner. Another company is selling off Care-UK’s 114 care homes. | Monday saw yet another care-home sell-off as Britain’s biggest provider, HC-One, went up for sale with 369 care homes. Four Seasons was taken over, after making a £450m loss for its private equity owner. Another company is selling off Care-UK’s 114 care homes. |
| The much-anticipated green paper on social care for older people is due to be published in the autumn of 2018. The government originally promised the green paper before last year's general election, but then said it would be unveiled before MPs' summer recess – although there were hopes it would appear much sooner. | |
| It was also hoped the paper would address needs across the entire adult social care sector. Instead, the paper will be limited to the government’s plans for improving care and support for older people and tackling the challenges presented by an ageing population. | It was also hoped the paper would address needs across the entire adult social care sector. Instead, the paper will be limited to the government’s plans for improving care and support for older people and tackling the challenges presented by an ageing population. |
| There will be a "parallel work stream" on working age disabled adults, but some are concerned this report will focus on getting more disabled people into work. | |
| The government has invited a number of people to advise on the paper, including Paul Burstow, chair of the Social Care Institute for Excellence; and Caroline Abrahams, charity director of Age UK. However, no user or care worker representatives have been invited. | The government has invited a number of people to advise on the paper, including Paul Burstow, chair of the Social Care Institute for Excellence; and Caroline Abrahams, charity director of Age UK. However, no user or care worker representatives have been invited. |
| During a cabinet reshuffle in early January, Jeremy Hunt became secretary of state for health and social care. Despite already having social care in his mandate, the change gave Hunt lead responsibility for the green paper. | During a cabinet reshuffle in early January, Jeremy Hunt became secretary of state for health and social care. Despite already having social care in his mandate, the change gave Hunt lead responsibility for the green paper. |
| The proposals set out in the paper will build on the additional £2bn the government has provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market over the next three years. Once published, the paper will be subject to a full public consultation. | The proposals set out in the paper will build on the additional £2bn the government has provided to meet social care needs, reduce pressures on NHS services and stabilise the social care provider market over the next three years. Once published, the paper will be subject to a full public consultation. |
| Care homes have been closing and the number of beds falling since 2015, despite soaring need. Costs rising far faster than inflation make them unsustainable as local authority fees fall, the minimum wage rises and immigration rules tighten, with social care consuming a third of council funds. | Care homes have been closing and the number of beds falling since 2015, despite soaring need. Costs rising far faster than inflation make them unsustainable as local authority fees fall, the minimum wage rises and immigration rules tighten, with social care consuming a third of council funds. |
| A devastating picture of the funding crisis emerges from a report by the King’s Fund, Ipsos Mori, the IFS and the Health Foundation, whose research director, Anita Charlesworth, warns many care homes now refuse to take state-funded residents. Despite a million more old people, social care cuts of £1.1bn mean 400,000 of those frail enough to qualify now get none at all, dumping many in the NHS. People falling and dying home alone don’t make the same noisy news as people dying in A&E corridors. | A devastating picture of the funding crisis emerges from a report by the King’s Fund, Ipsos Mori, the IFS and the Health Foundation, whose research director, Anita Charlesworth, warns many care homes now refuse to take state-funded residents. Despite a million more old people, social care cuts of £1.1bn mean 400,000 of those frail enough to qualify now get none at all, dumping many in the NHS. People falling and dying home alone don’t make the same noisy news as people dying in A&E corridors. |
| What’s clear from Ipsos Mori’s focus groups is that most funding solutions that look blindingly obvious to experts would be politically unacceptable to most voters. This is political deadlock, a Brexit-style popular resistance to the expert view that suggests untaxed property wealth should contribute more. That wealth belongs to the older generation who will need the care, so that looks like the commonsense source. Property is undertaxed in Britain so there’s symmetry and fairness in reaching into home values to pay for care. The young are already overburdened, paid less and owning less, so piling more on to their income tax seems unfair. | What’s clear from Ipsos Mori’s focus groups is that most funding solutions that look blindingly obvious to experts would be politically unacceptable to most voters. This is political deadlock, a Brexit-style popular resistance to the expert view that suggests untaxed property wealth should contribute more. That wealth belongs to the older generation who will need the care, so that looks like the commonsense source. Property is undertaxed in Britain so there’s symmetry and fairness in reaching into home values to pay for care. The young are already overburdened, paid less and owning less, so piling more on to their income tax seems unfair. |
| But “fairness” is in the eye of the beholder – and the beholders don’t like what they see. Ipsos Mori’s focus groups spent much time explaining the current system: “People know nothing,” they say. They don’t know everyone pays for residential care themselves if they have savings or property above a meagre £23,350. They don’t know they must sell their homes with no cap on what they might pay if they live long in a nursing home. They don’t know local authorities pay for care for those without funds: people still believe the convenient myth that a lifetime’s national insurance covers all. | But “fairness” is in the eye of the beholder – and the beholders don’t like what they see. Ipsos Mori’s focus groups spent much time explaining the current system: “People know nothing,” they say. They don’t know everyone pays for residential care themselves if they have savings or property above a meagre £23,350. They don’t know they must sell their homes with no cap on what they might pay if they live long in a nursing home. They don’t know local authorities pay for care for those without funds: people still believe the convenient myth that a lifetime’s national insurance covers all. |
| They think the very wealthy should pay more, but not themselves. A tax rise might be acceptable, but only if strictly hypothecated, as they don’t trust the money not to leach away – and they are right: hypothecation is an eye-catching gimmick to make a tax acceptable, but within a very few years it blurs into the general pot. | They think the very wealthy should pay more, but not themselves. A tax rise might be acceptable, but only if strictly hypothecated, as they don’t trust the money not to leach away – and they are right: hypothecation is an eye-catching gimmick to make a tax acceptable, but within a very few years it blurs into the general pot. |
| As for reaching into the value of homes, it causes an outraged sense of “unfairness”, even, astonishingly, among non-homeowners. As one respondent said, echoing many: “Just forget about touching people’s houses. That should be a principle. You work for that. It’s for generations to come. It’s yours.” | As for reaching into the value of homes, it causes an outraged sense of “unfairness”, even, astonishingly, among non-homeowners. As one respondent said, echoing many: “Just forget about touching people’s houses. That should be a principle. You work for that. It’s for generations to come. It’s yours.” |
| This feels like a brick wall and in one sense they are quite right. What we have now is a dementia tax by roll of the dice: lucky people drop dead while unlucky families forfeit everything if their parent has a long, expensive decline. A property tax is an essential part of any serious effort to redress inequality but it should be universal, unconnected to health and care needs. What emerges is a healthy belief in collective payment according to means and universal care according to need. | This feels like a brick wall and in one sense they are quite right. What we have now is a dementia tax by roll of the dice: lucky people drop dead while unlucky families forfeit everything if their parent has a long, expensive decline. A property tax is an essential part of any serious effort to redress inequality but it should be universal, unconnected to health and care needs. What emerges is a healthy belief in collective payment according to means and universal care according to need. |
| Pause here to look at the jaw-dropping figures in the King’s Fund report: just to keep the current miserable level of care will take £1.5bn extra by 2021, with more families losing everything. To go back to the (not very good) quality of 2010 would cost £8bn. The “cap and floor” of May’s manifesto, promising free care for those with less than £100,000 savings and that people could keep £100,000, whatever their care costs might be, costs £5bn more. But the outcry was over including their homes for the first time in the means test for domiciliary care – though overall there were more winners than losers. The Treasury balks at May’s expensive pledge that the green paper will put a cap on costs, a gift to well-off families. | Pause here to look at the jaw-dropping figures in the King’s Fund report: just to keep the current miserable level of care will take £1.5bn extra by 2021, with more families losing everything. To go back to the (not very good) quality of 2010 would cost £8bn. The “cap and floor” of May’s manifesto, promising free care for those with less than £100,000 savings and that people could keep £100,000, whatever their care costs might be, costs £5bn more. But the outcry was over including their homes for the first time in the means test for domiciliary care – though overall there were more winners than losers. The Treasury balks at May’s expensive pledge that the green paper will put a cap on costs, a gift to well-off families. |
| But how about free universal care? It’s the most expensive option, costing another £7bn by 2021 – but that’s only £2bn above May’s proposal. The Scots do it, and so could we. Tax rises would have to pay for it, notionally hypothecated to sugar the pill. Although this sum still only provides care at current miserable levels, it has one huge advantage: it aligns NHS and social care systems. The greatest barrier to uniting them seamlessly is that patients pay for care, but not for the NHS. | But how about free universal care? It’s the most expensive option, costing another £7bn by 2021 – but that’s only £2bn above May’s proposal. The Scots do it, and so could we. Tax rises would have to pay for it, notionally hypothecated to sugar the pill. Although this sum still only provides care at current miserable levels, it has one huge advantage: it aligns NHS and social care systems. The greatest barrier to uniting them seamlessly is that patients pay for care, but not for the NHS. |
| Labour could offer free universal care, but that might not help its credibility problem, as Labour is suspected of offering too much already. For the Tories, free care would be a landmark reputational game-changer, leaving Labour gasping for air. But Tories don’t do that kind of tax-raising or they wouldn’t be Tories. | Labour could offer free universal care, but that might not help its credibility problem, as Labour is suspected of offering too much already. For the Tories, free care would be a landmark reputational game-changer, leaving Labour gasping for air. But Tories don’t do that kind of tax-raising or they wouldn’t be Tories. |
| What will they do? The best bet is a little sticking plaster of extra funding and move on. To risk anything more radical, May could short-circuit the whole rigmarole of proposing, and then retreating, from anything unacceptable to the Daily Mail. Since that’s how she conducts government, just asking Paul Dacre what payments or new taxes he would tolerate would be a lot less effort than bothering with commissions or parliament. | What will they do? The best bet is a little sticking plaster of extra funding and move on. To risk anything more radical, May could short-circuit the whole rigmarole of proposing, and then retreating, from anything unacceptable to the Daily Mail. Since that’s how she conducts government, just asking Paul Dacre what payments or new taxes he would tolerate would be a lot less effort than bothering with commissions or parliament. |
| • Polly Toynbee is a Guardian columnist | • Polly Toynbee is a Guardian columnist |
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